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General NPI Number Information
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NPI Number | 1255127429
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Entity Type | Organization
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Legal Business Name | ELITE CREATIVE CARE LLC
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 01/14/2026
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Provider Practice Location Address
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Address Line | 33 CHURCHVILLE RD
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City | WEST POINT
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State | VA
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Zip | 23181-3519
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Country | US
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Telephone | 407-803-1144
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Fax | 804-557-9831
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Provider Business Mailing Address
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Address Line | 6500 W BANES CT
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City | CHESTERFIELD
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State | VA
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Zip | 23832-8249
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Country | US
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Telephone | 407-803-1144
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Fax | 804-557-9831
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Authorized Official
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Title or Position | OWNER
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Name | ALEXUS SHABAZZ
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Credential | LPC
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Telephone | 804-651-4879
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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